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Simple Summary: In spite of significant reductions in the numbers of animals entering shelters and being killed there over the last decades, the beliefs that companion animals must be under the direct control of a human guardian, and that capturing and often killing animals is morally justifiable and even necessary, continue to guide animal sheltering practices in the United States. Looking at the historical origins of animal control and sheltering in the US reveals a high level of consistency in ideologies and practices across almost 150 years. In this commentary, two scholars on animal sheltering in the US examine the historical legacies of animal control and sheltering in the US to show how they are problematic and dysfunctional and need to be abandoned to improve the lives of companion animals and the human communities of which they are a part. This paper examines the legacies of the emergence of the animal control and sheltering industry in the United States and their impact on contemporary public animal shelters. While decades of gradual reform have helped substantially reduce the number of animals entering shelters and being killed there, contemporary animal sheltering largely continues to follow the path set when animal sheltering developed in the late 1800s and early 1900s. Three key interrelated legacies of the pound model of early animal control and sheltering enduringly shape sheltering today: (1) the institutional culture of animal shelters grounded in the logics of caging and killing; (2) the lack of visibility and transparency, especially within government shelters; and (3) the economic logics of the pound model, including the disparities in sheltering resources across communities. Examining the origins of animal control and sheltering and identifying the specific legacies of this pound model within contemporary government-funded shelters improves understanding of why such shelters in the US have developed with a particular set of practices and ideologies, and thus provides an important footing for envisioning and enacting radical changes in animal sheltering. [ABSTRACT FROM AUTHOR]

Aim: This qualitative study explored de‐implementation of feeding tube auscultation practice in adult patients by critical care nurses. Background: Despite years of evidence suggesting inaccuracy and harm, auscultation (air bolus method) continues to be used by the majority of critical care nurses to verify small‐bore feeding tube placement in adults. Design This descriptive qualitative study used thematic analysis with telephone interview data. Methods: Fourteen critical care nurses from four stratified groups within the United States (by hospital type and auscultation practice) participated in telephone interviews. Results: Two major themes of individual influence and organizational leadership emerged from the data. Categories identified key components required for auscultation de‐implementation. Conclusions: Nurses feel obligated to follow hospital policies and expressed less accountability for their own practice. Organizational leadership involvement is recommended to facilitate de‐implementation of this tradition‐based, low‐value practice and mitigate harm events. Summary statement: What is already known about this topic? Auscultation is not an accurate method to identify feeding tube placement.Many critical care nurses continue to use the auscultation method (a low‐value, tradition‐based practice) to verify feeding tubes.Factors associated with de‐implementation of auscultation method for feeding tube verification are unknown. What this paper adds? Many nurses are aware that auscultation is not evidence based for adult feeding tube verification and are falsely comforted by hearing the whoosh sound (psychological bias).A combination of individual and organizational factors are barriers to de‐implementing auscultation of feeding tubes.Nurses seek guidance from leaders within their organization to facilitate de‐implementation, which is a necessary component of evidence‐based practice. The implications of this paper: A major challenge to de‐implementation of auscultation is the lack of valid bedside methods to assess feeding tube placement. Active involvement by organizational leaders will facilitate decision‐making to recommend a safe substitution for the auscultation method.Nurses expressed eagerness to incorporate evidence into their practice if they have adequate leadership support and the necessary resources to make practice changes.Formal intervention by organizational leaders is needed to promote de‐implementation of auscultation for feeding tubes. [ABSTRACT FROM AUTHOR]

Defence acquisition is a complex undertaking involving multiple actors and processes. However, in recent years, the US and UK defence acquisition frameworks have been criticised for not being able to cope with the complex and uncertain nature of defence. The paper takes this criticism and argues that defence acquisition is best understood as a "wicked problem" in which collective processes tie the system into large and interconnected networks of systems, not as a traditional linear science problem. In particular, the paper demonstrates that the Linear Transformation Model, at the heart of the US and UK defence acquisition framework, is ill-designed to cope with the complex and uncertain nature of both defence outputs and outcomes. The main reasons are technological maturity, information asymmetry and the need for interpretation and judgement. Furthermore, the paper elaborates that defence acquisition is characterised by a "problem of theory" and a "problem of practice" and that further research is necessary in order to transform its institutional culture and tackle the theory-practice divide with a more holistic approach. [ABSTRACT FROM AUTHOR]

This paper asserts that whiteness is a major ideological framework that is subtlety interwoven into our institutional structures and is a major organizing principle in the workplace. Efforts to increase racial equity, inclusion, and belongingness within the workplace and throughout society at large are ineffectual and virtually impossible without addressing the deleterious effects of whiteness. Addressing these pervasive subtleties in the workplace requires more than changing the complexion of an organization; instead, it also involves devoting ample attention to promoting widespread cultural change by being intentional about dismantling whiteness. An illustrative list of four preliminary steps for shifting the racial paradigm by attending to the ideology of whiteness in the workplace is provided. [ABSTRACT FROM AUTHOR]

This paper reports findings from a qualitative study on the triggers of hospital social workers' moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual's personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal hospital policies; and organizational values, such as perceptions of institutional support and validation. Implications of this research suggest that health systems need to foster positive ethical environments that nurture clinicians' health and mental health through programs that aim to increase moral resilience, promote empowerment, and foster wellness. [ABSTRACT FROM AUTHOR]

The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South. [ABSTRACT FROM AUTHOR]

In today's highly competitive world market, businesses can hardly maintain their competitiveness without strong innovation abilities. In the past, many Chinese enterprises have enjoyed success through imitation. But to continue to succeed in a global marketplace, they must develop ambidextrous innovation abilities. The resource‐based theory eloquently posits that competitive advantage is associated with different and heterogeneous resources. To obtain such resources, firms must establish an external network to acquire necessary knowledge and skills. In this paper, we develop a theoretical model linking network orientation, organisational improvisation, ambidexterity and competitive tension. We postulate that organisational improvisation has a mediating effect and competitive tension is a moderator. Empirical results (N = 340) show that (1) network orientation leads to both exploratory and exploitative innovations, (2) the above effect is mediated by organisational improvisation and (3) competitive tension positively moderates the effect between network orientation and organisational improvisation. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (VR) is increasingly used in organizational training interventions. However, few studies have systematically investigated VR compared to standard training methods in actual organizational contexts. Objectives: The focus of this study was to evaluate the effectiveness of a VR simulation for training professionals in the biotech industry. Aligning training needs to unique media affordances, the study designed an immersive story‐based VR simulation for training customer‐facing employees on a new product and tested it in an international biotech company. Methods: The system was evaluated by comparing its effectiveness to a traditional video presentation with the same content in a randomized between subjects experiment. The sample consisted of 95 employees across three locations: Brazil, Denmark, and USA. Results: The VR simulation group performed better than the video presentation group on the outcomes of conceptual knowledge (d = 0.41) spatial knowledge (d = 0.61), transfer intentions (d = 0.57), enjoyment (d = 1.74), self‐efficacy (d = 0.68), perceived learning (d = 0.89), personal value (d = 0.83), and organizational value (d = 0.82), but no significant difference was found for factual knowledge (d = −0.10). Implications: Results suggest that VR simulations can be effective across cultures in organizational training interventions. VR is specifically effective when the goals of the training are to increase conceptual and spatial understanding as well as enjoyment, and self‐efficacy, but not factual knowledge. Furthermore, employees report higher levels of perceived learning, personal and organizational value and transfer intentions after VR training compared to standard video‐based training. Lay Description: What is currently known about the subject matter: Immersive virtual reality (VR) is increasingly used in organizational training interventions. This interest has especially surged amid recent global challenges, and the sudden need for companies and employees to adapt to the new remote working conditions.However, few studies have systematically investigated VR compared to standard training methods in actual organizational contexts that include a real‐world scenario and a representative testing sample.Applied research that assesses the outcomes of VR based training in realistic learning and training settings is needed. What their paper adds: We propose and test an interdisciplinary approach that links unique features of VR with training needs and multidimensional outcome measures in an organizational training context within the biotech industry in Brazil, Denmark and USA.The findings suggest that a specifically designed VR tool is superior to a comparable video presentation for the outcomes of spatial and conceptual knowledge acquisition and transfer intentions, but not factual knowledge acquisition.The VR group also reported significantly higher personal value, organizational value, self‐efficacy, perceived learning, and enjoyment compared to the video group. Implications of study findings for practitioners: The results support the value of using VR simulations in organizational training, specifically related to affective outcomes as well as spatial and conceptual knowledge and transfer intentions.The study suggests that it is not the medium of VR, but rather the alignment between the training goals with the instructional methods and the unique affordances of VR that will contribute to better or worse learning outcomes.The article describes how to evaluate the effectiveness of VR tools in applied contexts, suggesting that we have to evaluate the effectiveness of tested content with respect to different outcome variables, which coincide with the training outcomes of a particular organizational context.The project as a whole, can be used as a blueprint for future applied research efforts, exemplifying how to bridge gaps between small‐medium‐enterprises, international corporate companies and academic institutions. [ABSTRACT FROM AUTHOR]

Purpose: In this paper, the authors examine how religious and political factors affect a firm's corporate governance diversity policies. Design/methodology/approach: The authors develop five basic empirical models. Model 1 examines how religious beliefs and political affiliation determine whether a firm will establish diversity incentive in its senior executives' performance assessment. Model 2 investigates how the diversity goal, religious beliefs and political affiliation separately affect the level of actual diversity achieved. Model 3 examines how the diversity goal and environmental factors interact to affect the level of actual diversity achieved. Model 4 and Model 5 examine whether the diversity incentive in senior executives' compensation plan and the environmental factors (religious belief and political affiliation) help to reduce the compensation differentials between male and female executives. Findings: The authors find that firms located in more liberal counties with more Mainline Protestants and less Republican voters in the United States are more likely to include workforce diversity as a criterion in evaluating their senior executives. The authors also provide evidence that firms with diversity goals have more female directors, more female senior executives and more minority directors. However, they find no evidence that the compensation differentials between male and female executives are smaller in these firms. Finally, they find that external environment affects the effectiveness of the implementation of the diversity goals. Originality/value: In line withthis branch of research, the authors expand the literate on the link between corporate culture and corporate decision-making by investigating the non-financial performance measures. Besides the corporate decision-making in investment, financial reporting and social responsibilities as documented in prior studies, the authors argue that the religious beliefs and political affiliations could also affect the development and implementation of corporate non-financial performance goals in executive incentive contracts. [ABSTRACT FROM AUTHOR]

There is a relationship between marginalized Black K-12 children and Black women in Corporate America. This practice results in Black K-12 children and Black women being undervalued on all levels. Highlighting personal experiences supports current assumptions around inequities, marginalization, and the Black lives Matter movement. At times, the more money you make, the more tolerant you are of the abuse. You become addicted to a lifestyle. I believed my corporate career was the best I would receive from a professional white-collar work environment. Did the inequities experienced in the U.S. K- 12 educational system prepare me to accept this belief in Corporate America? As a child, you learn about the American dream and capitalism. White Corporate America leaders received the same education with a higher probability of a more valuable educational experience. Would the Corporate America experience improve if White children learned about diversity, equity, and inclusion in K-12 to help them see differences as being valuable? Does their comfort level have a direct impact on Black people's assignments, exposure, and careers? My authentic story is shared for others with similar experiences to help them realize they are not alone. We must push past our fears and tell our stories. We should never be ashamed! I will continue to focus on the freedom that blossomed from the time I put pen to paper. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe and interpret the interpersonal and intragroup conflict experiences of staff-level employees and leaders in the medical imaging technology field, working in US tertiary care centers to extract mitigation and management strategies. Design/methodology/approach: A total of 13 medical imaging technologists, who were employed in leadership and staff positions throughout the USA, offered their in-depth accounts of workplace conflict in this interpretive phenomenological investigation. Findings: Conflict avoidance was a predominant conflict management style. This style did little to effectively manage workplace conflict. In some cases, it led to deleterious effects on individuals and organizations and created conflict perpetuation. With proper conflict mitigation and management, the conflict perpetuation cycle can be broken. Research limitations/implications: Generalization beyond the group being studied is not applicable, as it is not the intent of phenomenological research. Four leaders participated in the research study. To examine this population more completely, a greater sample size is required. This recommendation also applies to the staff technologist roles. Another limitation involved the leader/staff-level representation inequality, as well as the male–female representation. These imbalances made it difficult to effectively make comparisons of the experiences of leaders with staff-level technologists, and males with females. Practical implications: Offering the medical imaging workforce emotional intelligence training, health-care administrators can invest in their leaders and staff technologists. Medical imaging schools can incorporate emotional intelligence training into their curricula. Clear policies may decrease the ill effects of change when unforeseeable occurrences result in schedule modifications. Making technologists fully aware of who is responsible for shift coverage when these events occur may reduce negative impact. Trainings in organizational change, collaboration or positivity may be warranted, depending on findings of cultural assessments. Team-building events and opportunities for employees to intermingle may also be used to improve a departmental or organizational culture. Social implications: Mitigating and managing health-care workplace conflict more effectively may prevent patient harm, thus improving the health of members of society. Originality/value: According to recent studies, conflict, and the incivility that often accompanies it, has been on the increase in US organizations overall, and in health care specifically. Conflict that perpetuates can adversely affect health-care organizations and its employees. This paper offers mitigation and management strategies to prevent such consequences. [ABSTRACT FROM AUTHOR]

High annual turnover rates that plague child welfare agencies are costly and disrupt services. Numerous studies have focused on aspects of the workplace and the characteristics of child welfare workers that may be associated with leaving. Fewer studies have explored the types of worker supports that agencies can offer to encourage retention. This two-study paper utilized data from public child welfare caseworkers to examine predictors of self-reported intent to stay and its association with actually staying at the agency. Results of Study 1 indicated that that self-reported intent to stay was a key predictor of staying (as was number of years on the job). Results of Study 2 indicated that self-efficacy, peer support, supervision, and organizational supports were key predictors of intent to stay. Newer workers differed somewhat from more experienced workers, providing an opportunity for reflection on how agencies can best support staff during different phases of their career. [ABSTRACT FROM AUTHOR]

We live in ‘a world of clashing interests’ [Zinn, H. (1991).Declarations of independence: Cross-examining American ideology. Toronto: Harper Collins, p. xx]. In a grapple for survival, universities choose to spend less money and time on teaching and learning, less time on robust evaluation of student learning and concomitantly less active support for collaborative reflective practice. However, the situation is even more dire than that outlined above because university management seeks to portray its focus on teaching and learning as genuine and a priority. Considerable effort is spent on encouraging teachers to compete for teaching excellence awards at the same time as universities push academics harder and harder into ‘real research’, that is, research that is not about teaching and learning. This is further exacerbated by the use of teaching quality instruments which have been criticised as unreliable indicators of student learning. This paper argues that individual reflective practitioners collecting and collaborating together can advocate for teaching in the current higher education environment but the outreach of this advocacy is likely to be limited when the advocacy remains within ‘pockets of resistance’. To further promote change from within the institution and extend the breadth and depth of an individual's influence beyond the pockets of resistance, we suggest that individuals use collaborative reflective practice-based strategies aligned with each of the dimensions of the institution's ‘cultural web’. Collaborative reflective practice has the potential to advocate for teaching beyond small groups of enthusiasts because it taps into the often hidden but heart-felt passion and commitment to teaching held by many academics. [ABSTRACT FROM AUTHOR]

The article presents commentary on a paper in the current issue entitled "Expression of Espoused Humanizing Values in Organizational Practice: A Conceptual Framework and Case Study" by Brian Shapiro and Michael Naughton (S&N). The author notes S&N describe how precision-parts manufacturer Reell had to compromise its values by resorting to layoffs amid an economic recession that began in 2008, and says they do a good job of describing the conflict Reell faced between maintaining its values and its profitability.

Organizational support represents a critical driver of practice research projects. This analysis includes four international examples of such support (Norway, Finland, Belgium, and USA and China). The four studies capture the similarities and differences between university support and national government support. The analysis is placed within the context of defining practice research and the core components of organizational support. The findings emerged from presentations in a Practice Research Collaborative sponsored by the International Community on Practice Research in Social Work. The conclusion includes a discussion of a cross-case analysis along with the identification of implications for practice research studies in social work and affiliated professional disciplines. [ABSTRACT FROM AUTHOR]

Aim: To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self‐efficacy of reporting child abuse and neglect. Design: A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey. Methods: A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores. Results: Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self‐efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self‐efficacy of reporting child abuse and neglect. Conclusion: This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters. Implications for the profession and/or patient care: To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters. Impact: This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self‐efficacy in reporting suspected child abuse and neglect. Reporting methods: The authors of this study have adhered to relevant EQUATOR guidelines: STROBE. Patient or public contribution: There is no patient or public contribution as the study only looked at nurses. [ABSTRACT FROM AUTHOR]

Many teaching hospitals in the United States were founded on philanthropic principles and aimed to aid the urban poor and underserved. However, as times have changed, there has been a divide created between the urban poor and teaching hospitals. There is a plethora of reasons why this is the case. This paper will specifically focus on the histories of ten hospitals and medical schools and the effect that white flight, segregation, elitism, and marginalization had on healthcare institutions all over the United States. It will call for a reexamination of the values of Ivy League and Ivy Plus teaching hospitals and medical schools and for them to take an intentional look into their communities. [ABSTRACT FROM AUTHOR]

Using the case study approach, this paper examines the formation of a pan-Asian American ethnic agency between leaders of corporate employee resource groups and Asian American subgroup ethnic agencies. Themes found consist of 1) formation of the partnership to raise funds for a natural disaster; 2) moving forward as a united pan-Asian American nonprofit organization; and 3) challenges ahead that include utilization of funds and power 4t agency community members. A better-resourced organization can facilitate increased chances of success as well as access to its services by the community in which it serves. [ABSTRACT FROM AUTHOR]

Leading a startup business geared towards creating innovatory products and services is always going to be challenging for entrepreneurs. This task is difficult enough in established and developed economies such as the USA and Europe, but how about in emerging markets such as Iraq, with a history of war and sanctions, and Egypt, suffering from post-revolution chaos, uncertainty and devaluation? Setting up an entrepreneurial and highly innovatory business can be made even more difficult by having to cope with cultural differences. Here we look at the entrepreneurial challenges of operating in radically different environments and some of the distinct issues in the process of creating a culture of innovation. What do we know of the national cultural differences of these countries? These national cultural differences inevitably impact on the creation of an organizational culture, having their own implications for the challenges of leading innovation. This paper suggests that understanding national cultural differences can make all the difference between success and failure in leading innovation. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [ABSTRACT FROM AUTHOR]

This paper investigates how a US gold mining multinational enterprise (MNE) - one of the world's largest - operates its subsidiaries in various parts of the world by creating a unique ‘glocal identity’. The US parent company has experienced several significant challenges across its network of subsidiaries. These challenges were mostly linked to the enforcement of the MNE's identity and culture in its host environment. We contribute by describing, in detail, the attempts made by this company to localise its corporate social responsibility practices in Ghana as it sought to gain legitimacy and create an identity that would overcome the issues relating to the liability of foreignness. Our data come from a combination of sources, including questionnaires and detailed semi-structured interviews conducted with the key management employees of the mining company, members and opinion leaders of the company's host communities, and secondary sources. Our main finding is that the construction of a ‘host-friendly’ identity was centred around the mining company's involvement with the Newmont Ahafo Development Foundation. [ABSTRACT FROM AUTHOR]

Abstract: Medication errors continue to occur too frequently in the United States. Although the five rights of medication administration have expanded to include several others, evidence that the number of errors has decreased is missing. This study suggests that medication rights for nurses as they administer medications are needed. The historical marginalization of the voice of nurses has been perpetuated with detrimental impacts to nurses and patients. In recent years, a focus on the creation of a just culture, with a balance of accountability and responsibility, has sought to bring a fairer and safer construct to the healthcare environment. This paper proposes that in order for a truly just culture to exist, the balance must also include nurses’ authority. Only when a triumvirate of responsibility, accountability, and authority exists can an environment that supports reduced medication errors flourish. Through identification and implementation of Nurses Rights of Medication Administration, nurses’ authority to control the administration process is both formalized and legitimized. Further study is needed to identify these rights and how to fully implement them. [ABSTRACT FROM AUTHOR]

This paper details results of a study examining administrative case data from 2010-2015 from abortion funds serving the USA and the Republic of Ireland, Northern Ireland and the Isle of Man. Driven by the available data, the researchers compared organisational characteristics, patient characteristics, procedural costs, patient resources and the ratio between patient resources and procedural costs. Independent t-tests were conducted to assess whether differences in characteristics, costs or resources were significant. The number of patients serviced by abortion funds across the two datasets increased yearly from 2010-2015. While patients in the USA had more resources, on average, to contribute to their abortion procedure, Irish, Northern Irish and Manx patients had the resources to pay for a greater percentage of their costs, on average, which was mainly attributable to the differences in gestational age of those helped by the different abortion funds. Patients across all nations were similar in terms of their marital status, average age and number of existing children. Patients across these countries face expensive procedures and a lack of resources that are bridged in part by abortion fund assistance. [ABSTRACT FROM AUTHOR]

Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs. [ABSTRACT FROM AUTHOR]

Background: We sought to understand the innovativeness of nurses engaging in innovative behaviors and quantify the associated characteristics that make nurses more able to innovate in practice. We first compared the innovativeness scores of our population; then we examined those who self-identified as an innovator versus those who did not to explore differences associated with innovativeness between these groups. Methods: A cross-sectional survey study of nurses in the US engaging in innovative behaviors was performed. We performed an exploratory factor analysis (EFA) to determine the correlates of innovative behavior. Results: Three-hundred and twenty-nine respondents completed the survey. Respondents who viewed themselves as innovators had greater exposure to HCD/DT workshops in the past year (55.8% vs. 36.6%, p = 0.02). The mean innovativeness score of our sample was 120.3 ± 11.2 out of a score of 140. The mean innovativeness score was higher for those who self-identified as an innovator compared with those who did not (121.3 ± 10.2 vs. 112.9 ± 14.8, p =< 0.001). The EFA created four factor groups: Factor 1 (risk aversion), Factor 2 (willingness to try new things), Factor 3 (creativity and originality) and Factor 4 (being challenged). Conclusion: Nurses who view themselves as innovators have higher innovativeness scores compared with those who do not. Multiple individual and organizational characteristics are associated with the innovativeness of nurses. [ABSTRACT FROM AUTHOR]

Background: The Fire service Organizational Culture of Safety (FOCUS) survey is an assessment tool comprised of psychometrically validated metrics of safety climate, safety behavior, and downstream outcomes (organizational and injury) that are specific to the U.S. fire and rescue service. Methods: This analysis consists of a descriptive summary of two independent survey waves (FOCUS 1.0 and 2.0). The fire departments included in these survey waves were from convenience sampling (n1.0 = 275; n2.0 = 170). In addition to department level characteristics, we examined individual level characteristics for firefighters and EMS providers in participating departments (n1.0 = 22,719; n2.0 = 16,882). We conducted regression analyses to examine the associations between safety climate and safety behaviors, organizational outcomes, and safety outcomes. All analyses were stratified by organization type (career, volunteer). Results: Our analysis indicated that a majority of respondents were males (90.7%FOCUS 1.0; 90.4%FOCUS 2.0), non-officers (68.4%FOCUS 1.0; 66.4%FOCUS 2.0), and non-Hispanic Whites (70.8%FOCUS 1.0; 69.5%FOCUS 2.0). For both samples there was a higher prevalence of injuries among individuals in career departments (nFOCUS 1.0 = 3778 [17.5%]; nFOCUS 2.0 = 3072 [18.7%]) than volunteer departments (nFOCUS 1.0 = 103 [8.8%]; nFOCUS 2.0 = 34 [7.4%]). We observed an approximate 10-point difference between the mean scores of Management Commitment to Safety for career and volunteer departments in both samples. We observed associations for two organizational outcomes, Safety Behavior and Job Satisfaction, with Management Commitment to Safety and Supervisor Support for Safety overall and when stratified by organization type. We observed a decrease in the odds of injuries associated with a one-unit increase in Management Commitment to Safety (OR1.0 overall: 0.98, 95% CI 0.97–0.99; OR2.0 volunteer: 0.90, 95% CI 0.85–0.95) and Supervisor Support for Safety (OR1.0 overall: 0.95, 95% CI 0.93–0.97; OR1.0 career: 0.95, 95% CI 0.92–0.98). Conclusions: From our current study, and a prior analysis of a geographically stratified random sample of U.S. fire departments, we identified that from all the organizational outcomes, job satisfaction was most consistently associated with FOCUS safety climate. Further, firefighters in our samples consistently rated Supervisor Support for Safety higher than Management Commitment to Safety. Future interventions should support fire departments in improving their departmental Management Commitment to Safety and maintaining their Supervisor for Safety. [ABSTRACT FROM AUTHOR]

The article contains a systematic review of the scientific literature on the nurse turnover problem. It is analysed from two perspectives. Firstly, the topic of employees is discussed (increased workload, inconsistency of salary with the amount of work performed, standards for the number of patients assigned to one nurse, job dissatisfaction, limited opportunities for career growth and professional development, professional burnout, unregulated rest time between shifts, etc.). Secondly, medical institution is described (shortage of medical staff leads to a decrease in patient satisfaction, loss of care quality, increased waiting time for services, review of safety and patient care protocols, reduction in the number of patients who can receive medical care or consultation, which causes a decrease in hospital revenue, hinders organisational growth, raises the cost of additional recruitment, leads to medical errors that turn into lawsuits in future, etc.). In addition to personal and financial reasons, the medical staff turnover is often caused by purely organisational imbalances (in particular, the lack of a teamwork atmosphere in the hospital, an ineffective leadership model, an imperfect and stressful working environment, poor working conditions, poor relations between doctors and nurses, etc.). The article represents mechanisms for applying provisions of a number of theories and models to address the nurse turnover problem. Among examples, there are leadership models -- the contingency theory (concepts of adaptation, equivalence, effectiveness and congruence), the organisational culture theory like Hofstede's corporate culture theory (concepts of power distance, uncertainty avoidance, male / female values, collectivism / individualism, long-term / short-term orientation, indulgence / restraint), the change management theory like the Plan-Do-Study-Act cycle theory. Tenet Healthcare, Inc. was selected as a case study. One of the well-known and largest healthcare organisations in the United States, it has been experiencing significant problems with the nurse turnover since 2006, which is currently over 50% and higher than the industry average. Given the size of this organisation and its leading position in the US healthcare market, this problem poses a significant threat to the market as a whole, and Tenet Healthcare, Inc. is in immediate need of a comprehensive plan to address [ABSTRACT FROM AUTHOR]

Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations. [ABSTRACT FROM AUTHOR]

This content is provided by the American Academy of Family Physicians. [ABSTRACT FROM AUTHOR]

This paper underscores foe importance of fieldwork and contextualization in the sphere of English for specific purposes (ESP). It focuses on the milieu, discourse and culture of American multinational companies specialized in oil and gas (ExxonMobil, Chevron and Conoco Phillips) and agrochemistry (Monsanto, Dow AgroSciences and DuPont Pioneer). Because their activities are sometimes considered as a threat to health and the environment, the six firms were chosen as representative of the technological risk industry. The author's initial assumption was that they shared specific communication needs, making them a distinct discourse community within the corporate world. In order to check this hypothesis, an interdisciplinary methodology was used: genre analysis was combined with an ethnographic-driven approach to provide insight into the specific context that shapes the companies' culture and communication. The aim was to show that discourse analysis can be used as an entry point into a specialized community and should be complemented by other approaches. Combining data from different sources, this paper shows that the main objective of technological risk companies is not only to promote their products, but also to legitimize controversial activities and bolster their image. [ABSTRACT FROM AUTHOR]

Demand for acute care is forecasted to grow in the United States. To meet this demand, nurse practitioners (NPs) are increasingly employed in acute care settings. Yet, there is concern about an adequate supply of acute care NPs given demand. Further, professional nursing organizations recommend aligning an NP's role with their education, certification, licensure, and practice. Given workforce constraints and the policy environment, little is known about how hospitals approach hiring NPs for acute care roles. The purpose of this study was to explore advanced practice provider (APP) directors' approaches to hiring NPs within the context of alignment and describe factors that influence hiring decisions. We conducted semi-structured interviews with 17 APP directors in hospitals and health systems. Interviews were recorded, transcribed, and coded using an iterative, hybrid inductive and deductive method. Two themes emerged: (1) local factors that inform aligned hiring and (2) adaptive hiring responses to changing environments. Practices around hiring NPs varied across institutions influenced by organization and state policies and regulations, workforce availability, and institutional culture. Most APP directors recognized trends towards hiring aligned NPs for acute care roles. However, they also identified barriers to fully aligning their NP workforce and described adaptive strategies including hiring physician assistants, building relationships with APP schools, and leveraging hospital resources to develop the APP workforce to meet care delivery demands given the current NP workforce supply. Future research is needed to assess widespread practices around acute care NP alignment and the implications of alignment for patient and organizational outcomes. [ABSTRACT FROM AUTHOR]

This study contributes to the limited literature on the personal branding of knowledge workers by revealing that a culture that incorporates knowledge, learning, and collaboration supports (explicit and tacit) knowledge sharing among employees and that sharing matters for knowledge workers' self-perceived personal brand equity. Analysis of 2,168 cases from the United States and Poland using structural equation modeling (SEM) showed that this knowledge-sharing mechanism differs by country and gender. Findings revealed that in the United States, the knowledge culture and collaboration culture are highly correlated and dominate the learning culture. In both countries, the mistake acceptance component of the learning culture is not supported by knowledge culture as strongly as is the climate component. These findings reveal a bias concerning the acceptance of mistakes as a potential source of learning observed if the culture of knowledge dominates. Moreover, this study uncovers some significant gender differences that might be caused by the gender stereotypes existing in STEM (science, technology, engineering, mathematics). Finally, the study confirms that knowledge workers' personal branding is a potent motive to smoothen and increase the knowledge-sharing flow in knowledge-driven organizations. [ABSTRACT FROM AUTHOR]

This essay reflects on the history of napalm and the US anti-war movement to examine the university as both a site of research and development for chemical and biological warfare during the Cold War, as well as a site of abolitionist intervention and struggle. On one hand, napalm represented how war structured the fabric of everyday life in the United States, a condition of total war that overtook institutions of knowledge production within universities, corporations, and laboratories across the nation. On the other hand, napalm was viewed as exceptionally inhumane compared to other tactics of war, prompting movements for outlawing the chemical from military use. This dissonance between organizing against war itself as a perpetual structure of violence and against napalm as an individual technology of war invites consideration of the material stakes of anti-war organizing in an abolitionist vision. As the military–industrial complex only strengthens the entanglements between the university, corporate capitalism, and military expansion, this essay asks: how might we grapple with our place as abolitionist and anti-militarist scholars to interrogate our relationship to knowledge production and the university itself? [ABSTRACT FROM AUTHOR]

Muslims in Europe have set up numerous initiatives aimed at reconciling religious life in modern societies. Whether they revolve around food certification, finance, education, or newly founded businesses that try to provide products and services compliant with religious prescriptions. Many charities are alternative safe spaces where people who share the same spirituality and ethics can connect and work together. Reviving Islamic traditions, such as shura, sharing a rejection of consumerism, and designing modes of governance opposed to bureaucracy, they may appear as rejecting modern models. However, inspired by the financially successful methods of big multinational companies, some charities try to design modes of action that try to emulate corporate culture. Becoming driven by results and figures such as “likes” on Facebook, retweets, and “views” on YouTube, they adapt their interpretation of the Qur’an and the hadith to justify material success as a means to achieve happiness. This paper analyses how, from a tradition rejecting materialism, some Muslim charities paradoxically develop a utilitarian mindset, and how corporate culture impacts the not-for-profit sector. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements. [ABSTRACT FROM AUTHOR]

Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]

As older workers leave the workforce, they take their human capital and specific skill sets with them. Their retirement will have significantly adverse effects on the numerous sectors that employ older adults, including government, public administration, education, and healthcare. This perspective paper describes some factors that hinder or support continued employment of occupational therapy practitioners over the age of 50 and suggests workplace accommodations and considerations that might allow some to work longer in the field. A literature review shows that flexible scheduling, ergonomic design, assistive technology, mentoring, continued training, and appreciation of diversity can support continued employment. The need for healthcare providers is only expected to grow in the near future. Providing accommodations and anticipating the needs of older workers may allow them to stay in the workforce longer. Supporting generational diversity in the healthcare workforce can benefit consumers, providers, and the system at large.who surveyed variables in the social determinants of health model: illicit drug use contributes to poorer health associated with drug-induced illness and premature death. [ABSTRACT FROM AUTHOR]

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

Background: Improving outcomes for patients with acute myocardial infarction (AMI) is a priority for hospital leadership, clinicians, and policymakers. Evidence suggests links between hospital organizational culture and hospital performance; however, few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with AMI. We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). Methods: This manuscript describes the methodology of LSL, a 2-year intervention study using a concurrent mixed methods design, guided by open systems theory and the Assess, Innovate, Develop, Engage, Devolve (AIDED) model of diffusion, implemented in 10 U.S. hospitals and their peer hospital networks. The intervention has three primary components: 1) annual convenings of the ten intervention hospitals; 2) semiannual workshops with guiding coalitions at each hospital; and 3) continuous remote support across all intervention hospitals through a web-based platform. Primary outcomes include 1) shifts in key dimensions of hospital organizational culture associated with lower mortality rates for patients with AMI; 2) use of targeted evidence-based practices associated with lower mortality rates for patients with AMI; and 3) in-hospital AMI mortality. Quantitative data include annual surveys of guiding coalition members in the intervention hospitals and peer network hospitals. Qualitative data include in-person, in-depth interviews with all guiding coalition members and selective observations of key interactions in care for patients with AMI, collected at three time points. Data integration will identify patterns and major themes in change processes across all intervention hospitals over time. Conclusions: LSL is novel in its use of a longitudinal mixed methods approach in a diverse sample of hospitals, its focus on objective outcome measures of mortality, and its examination of changes not only in the intervention hospitals but also in their peer hospital networks over time. This paper adds to the methodological literature for the study of complex interventions to promote hospital organizational culture change. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to compare and understand how age, gender and culture affect individual career and work-related attitudes in Chinese and American samples. Design/methodology/approach -- Online and printed questionnaires were administered to employees and managers in China, whereas in the USA, faculty, staff and students at a Midwestern university responded to an online survey. Snowball sampling technique was used to collect data. Independent sample t-tests were conducted to test the hypothesis. Findings -- The study showed different work values and attitudes in the workplace between Chinese and the US samples, and indicated the specifics influences that national culture has on them. Culture affects generational changes; generational differences in the US sample are bigger than in Chinese sample; work values differ across generations and cultures; traditional gender role differences persist more strongly across generations in Chinese sample than in the US sample. Research limitations/implications -- Generalizability issues; cross-sectional data. Practical implications -- US-based multi-national corporations need to understand these differences and better manage their diverse employees operating in China. Originality/value -- This study compared generation, culture and gender differences simultaneously; parallel groups at similar life stages were used by basing the boundaries of each generation on the distinct cultural events of each nation. This approach is more consistent with generation definitions than by using influential specific events of each country, respectively. Useful to managers, it will provide guidance for understanding work values and attitudes across gender and generations in the USA and China. Most benefit will occur for US based multinational companies that have Chinese operations, and manage employees with cultural, gender and generational differences. [ABSTRACT FROM AUTHOR]

Background: Nurses experience a constellation of negative outcomes such as lost productivity, based on their high levels of organizational stress. Following recommendations for best practices in health communication can dramatically improve the organizational climate for nurses and can have a significant effect on patient outcomes. In this study, we evaluate the impact of Communicative Restricted Organizational Stress (CROS) and effort-reward imbalance (ERI). Methods: A mixed-methods approach was employed. A professional survey research vendor was contracted to obtain an appropriate national sample (N = 299) of working nurses in the United States of America. Participants completed an online closed-ended questionnaire for the quantitative portion of the study. Qualitative data were gathered from member-checking follow-up interviews. Results: Results of the quantitative analysis indicated that nurses experience CROS, that these experiences are distressing, that CROS functions as an effort in the effort-reward-imbalance model, and that CROS and ERI contribute to negative outcomes such as insomnia, productivity lost, and poor general health. Specifically, a moderated moderation model accounted for 53% of the variance [F (7,290) = 47.363, p <.001] indicating that nurses with high levels of CROS distress and low levels of organizational support experienced the highest level of ERI in the presence of high nursing stress, t (296) = 3.05, p =.03, 95% CI [0.0038, 0.0178]. These findings were validated through member-checking qualitative interviews and specific overarching themes were explicated. Conclusions: CROS is an important variable in understanding the experience of nursing stress. Furthermore, CROS serves as an effort in the ERI Model and serves to exacerbate nursing stress. We recommend practical implications for the improvement of psychosocial stress in an occupational environment for nurses. [ABSTRACT FROM AUTHOR]

Founded in 1929 by Emory S. Bogardus, the PSA is the oldest regional sociological association. During its 85-year history, the association has steadily increased in membership, participation, registration and size of its annual meeting, complexity of organizational structure, and has moved from a gemeinshaft to a gesellshaft culture and to a more inclusive and democratic association. Much of this change has mirrored the growth of sociology in general and of higher educational institutions in U.S. and has been made possible essentially through the work and effort of volunteers. [ABSTRACT FROM AUTHOR]

Research background: Audits are intended to ensure the reliability of financial statements, as this is fundamental for different stakeholders. However, both auditor tenure and audit fees could affect the earnings management of companies. In 2014, the European Union established a mandatory audit firm rotation policy. In the United States, although there is still no mandatory regulation in this regard, there has been a large public debate over the advisability of this policy. Another unresolved controversy is whether audit fees determine audit quality. Purpose of the article: The aim of this research is to study the effect of auditor tenure and audit fees on earnings management, i.e., to determine whether a longer-term relationship between the auditor and the audited company, as well as higher audit fees, reduce the audited company's earnings management, thereby making the financial statements more reliable for stakeholders and increasing the quality of the audit report. In addition, the Big Four auditing companies in the United States were analyzed in order to determine the influence of corporate culture. Methods: A sample of companies listed in the S&P 500 stock market index was employed for the analysis, covering the years 2012 to 2021, resulting in a dataset comprising 3,010 observations. To examine the research hypotheses while mitigating the potential bias from omitted variables, a linear regression analysis was conducted using panel data with fixed effects regression. To enhance the robustness of the results, winsorized variables were also employed. Findings & value added: Overall, the results confirm that the quality of financial statements improves as auditor tenure increases, and so implementing a mandatory auditor rotation may not be in a company's best interests. The results also support the market segmentation theory, as higher audit fees are aligned with higher quality financial reporting. Furthermore, by analyzing the Big Four audit companies in the US, it is shown that the influence of audit fees and auditor tenure on earnings management also depends on the internal aspects of the particular audit firm, especially its ethical culture. In sum, US policymakers should neither set limits on audit fees nor enforce a mandatory audit firm rotation similar to that of the EU. [ABSTRACT FROM AUTHOR]

Objectives: Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. Methods: Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. Results: Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = − 0.27, p < 0.01), and burnout (r = − 0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. Conclusions for Practice: Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life. Significance: What is already known on this subject? Studies on traumatic birth experiences rarely consider the impact on the providers caring for those patients. Few studies have elucidated the impact of work-related trauma on labor and delivery clinicians or considered whether it may contribute to burnout. What this study adds? This study found that involvement in traumatic birth experiences can affect labor and delivery clinician's professional quality of life, their interactions with patients, and desire to stay in the field. However, there is little acknowledgement or supports to mitigate these impacts in the workplace. Proactively investing in health care system supports for clinicians may mitigate clinician burnout and secondary traumatic stress and improve compassion satisfaction. [ABSTRACT FROM AUTHOR]

Background and Purpose: It is critical to accurately measure and understand the nurse practitioner (NP) work environment in which individual NP information is gathered but decisions or inferences are made at an aggregated, group level. However, there is little research on preconditions of aggregating individual-level data into group level in nursing research. This study was conducted to assess the multilevel reliability and group interrater agreement (IRA) of the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Methods: Secondary data analysis from a cross-sectional survey with 247 NPs in 112 practices across 6 U.S. states in 2018–2019 was used. Results: The generalizability coefficients and values of IRA were acceptable (>.70), and values of ICC(1) were significant (.18–.38). Conclusions: Aggregating individual NP data to a higher group-level work environment construct is acceptable. [ABSTRACT FROM AUTHOR]